Development of an Isokinetic Functional Electrical Stimulation Cycle Ergometer

An isokinetic functional electrical stimulation leg cycle ergometer (iFES‐LCE) was developed for individuals with spinal cord injury (SCI). The iFES‐LCE was designed to allow cycle training over a broad range of pedalling cadences (5–60 rev/min) to promote both muscular strength and cardiorespiratory fitness. A commercially available motorized cycle ergometer was integrated with a custom built FES system, a laptop computer, and a specialized chair that restricted lateral leg movements. Sample biomechanical data were collected from an SCI subject performing FES cycling to demonstrate the iFES‐LCE's performance characteristics. Calibration of the iFES‐LCE system revealed a linear relationship between torque applied to the axle of the motorized ergometer and the braking motor current generated to maintain velocity. Performance data derived from iFES‐LCE motor torque agreed closely with similar data collected using strain‐gauge instrumented pedals (cross‐correlations = 0.93–0.98). The iFES‐LCE was shown to work well across a range of pedaling cadences. We conclude that the new iFES‐LCE system may offer improved training potential by allowing cycling over a broad range of pedaling cadences, especially low cadence. This device also improves upon the accuracy of other ergometers by adjusting for the passive load of the legs.     

Walking along circular trajectories in Parkinson's disease

We hypothesized that gait capacities would be more stressed in patients with Parkinson's disease (PD) when walking along curved than straight trajectories, owing to the complex adaptations required for this walking task. Twenty on‐phase patients with PD and 20 healthy subjects walked eyes‐open along straight and curved trajectories for 1 minute at self‐paced cadence and velocity. Step frequency along straight and curved trajectories was computed from video‐recordings of the lower limbs. Step frequency was not affected by trajectory shape in either patients with PD or healthy subjects. Distances run by the patients were shorter than normal under both conditions. However, in PD, distances were relatively shorter during curved than straight walking; therefore, decreased distances in PD were connected with decreased mean step length (as the ratio between distance and step number). No correlation was found between the above mentioned variables and the severity or duration of the disease or the frequency of falls. Walking along curved trajectories can highlight impaired gait control in on‐phase patients with PD, and can be suitable for the routine evaluation of possible walking disorders when straight walking is not significantly affected. © 2008 Movement Disorder Society     

The assessment of gait disorders in patients with Parkinson's disease using the three-dimensional motion analysis system Vicon

BACKGROUND AND PURPOSE: Gait disorders are a common symptom of Parkinson's disease (PD) and can occur in the early stage of the disease. The most characteristic gait disorders in that disease affect pace and cadence. This study was designed to assess spatiotemporal and kinematic gait parameters of patients with PD using the three-dimensional motion analysis system Vicon. MATERIAL AND METHODS: 32 patients (14 women and 18 men; age range: 50-75) treated for PD in the Department of Neurology were studied. The control group consisted of 32 healthy persons (13 women and 19 men, age range: 52-77). Gait analysis using the Vicon 3D system took place in the Biokinetics Laboratory in the Academy of Physical Education in Kraków. The Vicon 3D system enables computerized registration and analysis of motion in three-dimensional space. RESULTS: The analysis of basic spatiotemporal parameters of gait revealed that PD patients had considerably lower walking speed, stride length and cadence and longer time of double support than controls. The assessment of kinematic gait parameters showed that PD patients had decreased motion range in the joints of the lower limbs and began the double support phase earlier and delayed the swing phase when compared to healthy controls. CONCLUSION: Our study shows a difference between PD patients and healthy controls at similar age both in angle changes and in spatiotemporal parameters of gait.     

Gait pattern in myotonic dystrophy (Steinert disease): a kinematic, kinetic and EMG evaluation using 3D gait analysis

We investigated the gait pattern of 10 patients with myotonic dystrophy (Steinert disease; 4 females, 6 males; age: 41.5+7.6 years), compared to 20 healthy controls, through manual muscle test and gait analysis, in terms of kinematic, kinetic and EMG data. In most of patients (80%) distal muscle groups were weaker than proximal ones. Weakness at lower limbs was in general moderate to severe and MRC values evidenced a significant correlation between tibialis anterior and gastrocnemius medialis (R=0.91). An overall observation of gait pattern in patients when compared to controls showed that most spatio-temporal parameters (velocity, step length and cadence) were significantly different. As concerns kinematics, patients' pelvic tilt was globally in a higher position than control group, with reduced hip extension ability in stance phase and limited range of motion; 60% of the limbs revealed knee hyperextension during midstance and ankle joints showed a quite physiological position at initial contact and higher dorsiflexion during stance phase if compared to healthy individuals. Kinetic plots evidenced higher hip power during loading response and lower ankle power generation in terminal stance. The main EMG abnormalities were seen in tibialis anterior and gastrocnemius medialis muscles. In this study gait analysis gives objective and quantitative information about the gait pattern and the deviations due to the muscular situation of these patients; these results are important from a clinical point of view and suggest that rehabilitation programs for them should take these findings into account.     

Spatiotemporal gait patterns during over ground locomotion in major depression compared with healthy controls

Alterations of locomotion are frequent, observable features of patients suffering from depression and have been investigated in these patients by actigraphy, cinematography and ground reaction forces. However, spatiotemporal parameters and neurophysiological mechanisms of gait have not yet been studied in depth in depression. The relationship between spatial and temporal parameters may yield insight into the pathophysiology of altered movements in depression. Therefore, gait patterns were quantitatively assessed and analysed in depressed subjects (n=16) and compared to matched healthy controls. Spatiotemporal gait parameters were measured during over ground walking at self-selected walking speed on a walkway previously validated in healthy subjects and used for orthopaedic and neurological patients. Compared to controls, depressed patients showed significantly lower gait velocity (p<0.001), reduced stride length (p<0.005), double limb support (p<0.005) and cycle duration (p<0.005). There was a significant correlation between cadence and gait velocity in depressed patients (r=0.51, p<0.05), but not in healthy controls (r=0.11, p>0.05). In patients with major depression, reduced gait velocity was associated with stride hypometria and increased cycle duration. Velocity was associated with cadence in depressed patients but not in healthy controls. The results may indicate possible deficiencies in the motor control system in depression. These first results about alterations of spatiotemporal gait patterns in depression warrant further longitudinal and experimental studies.     

Changes in gait and fatigue from morning to afternoon in people with multiple sclerosis

OBJECTIVES: The aim was to measure changes in walking patterns and self rated fatigue in people with multiple sclerosis (MS) compared with age matched control subjects, from the morning to the afternoon within a single day. METHODS: Fourteen patients with MS and the same number of matched control subjects performed four 10 m gait trials at their preferred walking speed at 10 00 am and then again at 3 00 pm on the same day. Gait speed, stride length, cadence, and the percentage of the gait cycle spent in double limb support were measured using a foot switch stride analyzer. Patients with MS also self rated their fatigue levels in the morning and afternoon using an 11 point scale. RESULTS: Compared with control subjects, patients walked very slowly, with reduced stride length and around twice as much variability in gait performance. Although self rated fatigue significantly increased from the morning to the afternoon, walking patterns remained consistent in both groups over the course of the day. CONCLUSIONS: These findings imply that mechanisms controlling locomotion are separate from those regulating perceived fatigue. Objective measures of performance, rather than self report, should be used to monitor change in patients with multiple sclerosis.     

Tibialis anterior architecture, strength, and gait in individuals with cerebral palsy

Introduction: The relationship of tibialis anterior (TA) muscle architecture, including muscle thickness (MT), cross‐sectional area (CSA), pennation angle (PA), and fascicle length (FL), to strength and ankle function was examined in ambulatory individuals with CP and unilateral foot drop. Methods: Twenty individuals with CP participated in muscle ultrasound imaging, unilateral strength testing, and three‐dimensional gait analysis. Results: Muscle size (MT and CSA) was positively related to strength, fast gait velocity, and ankle kinematics during walking. Higher PA was related to a more dorsiflexed ankle position at initial contact and inversely with fast gait velocity. FL was related to strength, fast velocity, and step length at a self‐selected speed. Conclusions: Muscle architecture partially explains the degree of impairment in strength and ankle function in CP. Treatments to increase TA size and strength may produce some gait improvement, but other factors that may contribute to ankle performance deficits must be considered. Muscle Nerve, 2011     

Falls and stumbles in myotonic dystrophy

OBJECTIVE: To investigate falls and risk factors in patients with myotonic dystrophy type 1 (DM1) compared with healthy volunteers. METHODS: 13 sequential patients with DM1 from different kindreds were compared with 12 healthy volunteers. All subjects were evaluated using the Rivermead Mobility Index, Performance Oriented Mobility Assessment, and modified Activities Specific Balance Confidence scale. Measures of lower limb muscle strength, gait speed, and 7-day ambulatory activity monitoring were recorded. Subjects returned a weekly card detailing stumbles and falls. RESULTS: 11 of 13 patients (mean age 46.5 years, seven female) had 127 stumbles and 34 falls over the 13 weeks, compared with 10 of 12 healthy subjects (34.4 years, seven female) who had 26 stumbles and three falls. Patients were less active than healthy subjects but had more falls and stumbles per 5000 right steps taken (mean (SD) events, 0.21 (0.29) v 0.02 (0.02), p = 0.007). Patients who fell (n = 6) had on average a lower Rivermead Mobility score, slower self selected gait speed, and higher depression scores than those who did not. CONCLUSIONS: DM1 patients stumble or fall about 10 times more often than healthy volunteers. Routine inquiry about falls and stumbles is justified. A study of multidisciplinary intervention to reduce the risk of falls seems warranted.     

Three-dimensional motion analysis of the effects of auditory cueing on gait pattern in patients with Parkinson’s disease: a preliminary investigation

Auditory cueing enhances gait in parkinsonian patients. Our aim was to evaluate its effects on spatiotemporal (stride length, stride time, cadence, gait speed, single and double support duration) kinematic (range of amplitude of the hip, knee and ankle joint angles registered in the sagittal plane) and kinetic (maximal values of the hip and ankle joint power) gait parameters using three-dimensional motion analysis. Eight parkinsonian patients performed 12 walking tests: 3 repetitions of 4 conditions (normal walking, 90, 100, and 110% of the mean cadence at preferred pace cued walking). Subjects were asked to uniform their cadence to the cueing rhythm. In the presence of auditory cues stride length, cadence, gait speed and ratio single/double support duration increased. Range of motion of the ankle joint decreased and the maximal values within the pull-off phase of the hip joint power increased. Thus, auditory cues could improve gait modifying motor strategy in parkinsonian patients.     

Falls in Parkinson's disease: Kinematic evidence for impaired head and trunk control

Changes in stride characteristics and gait rhythmicity characterize gait in Parkinson's disease and are widely believed to contribute to falls in this population. However, few studies have examined gait in PD patients who fall. This study reports on the complexities of walking in PD patients who reported falling during a 12‐month follow‐up. Forty‐nine patients clinically diagnosed with idiopathic PD and 34 controls had their gait assessed using three‐dimensional motion analysis. Of the PD patients, 32 (65%) reported at least one fall during the follow‐up compared with 17 (50%) controls. The results showed that PD patients had increased stride timing variability, reduced arm swing and walked with a more stooped posture than controls. Additionally, PD fallers took shorter strides, walked slower, spent more time in double‐support, had poorer gait stability ratios and did not project their center of mass as far forward of their base of support when compared with controls. These stride changes were accompanied by a reduced range of angular motion for the hip and knee joints. Relative to walking velocity, PD fallers had increased mediolateral head motion compared with PD nonfallers and controls. Therefore, head motion could exceed “normal” limits, if patients increased their walking speed to match healthy individuals. This could be a limiting factor for improving gait in PD and emphasizes the importance of clinically assessing gait to facilitate the early identification of PD patients with a higher risk of falling. © 2010 Movement Disorder Society     

Gait Improvement in Patients with Cerebral Palsy by Visual and Auditory Feedback

Objectives: To study the effects of gait training with visual and auditory feedback cues on the walking abilities of patients with gait disorders due to cerebral palsy. Materials and Methods: Visual and auditory feedback cues were generated by a wearable device, driven by inertial sensors. Ten randomly selected patients with gait disorders due to cerebral palsy and seven age‐matched healthy individuals trained with visual feedback cues, while ten patients and eight age‐matched healthy individuals trained with auditory feedback cues. Baseline performance (walking speed and stride length along a 10‐m straight track) was measured before device use. Following 20‐min training with the device and a 20‐min break, performance without the device was measured again and compared with the baseline performance. Results: For the patients who trained with visual feedback, the average improvement was 21.70% ± 36.06% in the walking speed and 8.72% ± 9.47% in the stride length. For the patients who trained with auditory feedback, the average improvement was 25.43% ± 28.65% in the walking speed and 13.58% ± 13.10% in the stride length. For the healthy individuals who trained with visual feedback, the average improvement was ?2.41% ± 9.54% in the walking speed and ?2.84% ± 10.11% in the stride length. For the healthy individuals who trained with auditory feedback, the average improvement was 0.01% ± 7.73% in the walking speed and ?2.03% ± 6.15% in the stride length. Conclusions: Training with visual and auditory feedback cues can improve gait parameters in patients with gait disorders due to cerebral palsy. This was contrasted by no improvement in age‐matched healthy individuals.     

A meta-analysis of gait in adolescent idiopathic scoliosis

This study aimed to compare the results of gait analysis of adolescent idiopathic scoliosis (AIS) patients and healthy subjects through a meta-analysis of the existing research. The Medline (via PubMed), Cochrane, Scopus, and Embase databases were searched for studies that evaluated the findings of AIS, including spatiotemporal parameters (walking speed, step length, cadence, and stance phase duration), segmental kinematics (frontal, sagittal, and transverse pelvic motion), and electromyographic variables (electrical activity of the quadratus lumborum, erector spinae, and gluteus medius), and were published between January 2000 and May 2020. Two authors extracted the data independently, and any discrepancies regarding the eligibility of retrieved studies were resolved by a consensus. Six comparative studies were identified and subsequently analyzed. It was found that the stance phase and frontal pelvic motion were significantly reduced in AIS patients compared with healthy controls. No significant difference was observed for speed, step length, cadence, sagittal pelvic motion, and transverse pelvic motion. The electrical activity durations of the quadratus lumborum, erector spinae, and gluteus medius were significantly increased in the AIS group compared with healthy subjects. Despite the heterogeneity, a limited number of meta-analyses showed reduced stance phase and frontal pelvic motion with prolonged activation timing of the quadratus lumborum, erector spinae, and gluteus medius muscles. Hence, further large-scale, multicenter studies are required to validate our results.     

双任务步行对缺血性卒中患者步态参数影响的研究

目的 探讨双任务步行（dual-task walking,DTW）对缺血性卒中患者步态参数的影响。 方法 前瞻性入组2020年6月-2021年3月于首都医科大学附属北京天坛医院康复科住院的缺血性 卒中患者。选择时钟任务作为DTW中的认知任务,受试者依次完成单任务步行（single-task walking, STW）和DTW。使用Codamotion三维动作捕捉系统采集患者执行任务时步态的运动学参数（膝关节、踝 关节活动范围、最大屈膝角度、最大伸膝角度、最大踝背屈角度、最大踝跖屈角度）和时空参数（步 速、跨步长、跨步时间、跨步速度、步长、步长时间、步频、支撑期百分比）,计算时空参数的变异系数。 比较患者进行STW和DTW时上述步态参数的差异。 结果 本研究共纳入28例缺血性卒中患者,男性20例（71.4%）。患者进行STW和DTW时步态的 运动学参数差异无统计学意义。在时空参数方面,与STW时相比,进行DTW时患者的步速降低 （0.69±0.23 m/s vs 0.80±0.27 m/s,P＜0.001）、步长（0.41±0.11 m vs 0.46±0.12 m,P＜0.001）和跨 步长缩短（0.85±0.20 m vs 0.95±0.22 m,P＜0.001）。在时空参数变异性方面,与STW比较,卒中患 者进行DTW时步长时间变异性[4.47（2.98～7.34）vs 2.58（1.76～4.27）,P＝0.013]及步频变异性[4.59 （2.78～7.78）vs 2.71（1.84～4.44）,P＝0.020]增加。 结论 卒中患者在进行DTW时更容易发现步态问题。与STW相比,双任务条件下的步态评估可能是 更有效的卒中康复评估指标,也更适用于卒中后康复训练计划。     

Gait and balance in essential tremor: Variable effects of bilateral thalamic stimulation

Essential tremor (ET) is a multi‐faceted condition best known for postural and action tremor but also may include disordered gait and postural instability. Deep brain stimulation (DBS) of the ventral intermediate nucleus (VIM) of the thalamus provides substantial tremor reduction yet some patients with bilateral VIM DBS have gait and balance impairment. This study examines gait and balance performance in 13 participants with ET who have bilateral VIM DBS compared with a matched control group. Participants with ET were tested with their stimulators off (DBS OFF) and on (DBS ON). For both standard and tandem walking, participants with ET walked significantly more slowly than controls, with significantly lower cadence, spending a lower percentage of the gait cycle in single limb support and a higher percentage in double support compared with controls. Participants with ET also had significantly lower tandem and one leg stance times, Berg balance scores, balance confidence, and required significantly greater time to perform the Timed Up‐and‐Go relative to controls. There were no significant differences in any gait or balance measures in the DBS OFF versus DBS ON conditions, but the effects of DBS on gait and balance were highly variable among individuals. Future studies are needed to determine why some individuals experience gait and balance difficulties after bilateral thalamic DBS and others do not. A better understanding of the mechanisms underlying gait and balance impairments in those with bilateral DBS is critical to reduce falls and fractures in this group. © 2008 Movement Disorder Society     

双任务步行对缺血性卒中患者认知-运动干扰的影响研究

目的 探讨缺血性卒中患者和健康人在进行双任务步行(dual-task walking,DTW)时,不同认知任务对步态和认知-运动干扰(cognitive-motor interference,CMI)的影响.方法 选取24例急性缺血性卒中患者为卒中组,并选取与卒中组性别、年龄、受教育程度相匹配的16例健康志愿者为对照组...     

Robot-assisted training using Hybrid Assistive Limb® for cerebral palsy

Purpose

The Hybrid Assistive Limb® (HAL®, CYBERDYNE) is a wearable robot that provides assistance to a patient while they are walking, standing, and performing leg movements based on the wearer’s intended movement. The effect of robot-assisted training using HAL® for cerebral palsy (CP) is unknown. Therefore, we assessed the effect of robot-assisted training using HAL® on patients with CP, and compared walking and gross motor abilities between pre-intervention and post-intervention.

Altered frontostriatal coupling in pre‐manifest Huntington’s disease: effects of increasing cognitive load

Background and purpose: Functional neuroimaging studies have suggested a dysfunction of prefrontal regions in clinically pre‐symptomatic individuals with the Huntington’s disease (HD) gene mutation (pre‐HD) during cognitive processing. The objective of this study was to test the impact of cognitive demand on prefrontal connectivity in pre‐HD individuals. Methods: Sixteen healthy controls and sixteen pre‐HD subjects were studied using functional MRI and a verbal working memory task with increasing cognitive load. Load‐dependent functional connectivity of the left dorsolateral prefrontal cortex (DLPFC) was investigated by means of psychophysiological interactions. Results: In pre‐HD subjects, aberrant functional connectivity of the left DLPFC was found at high working memory load levels only. Compared with healthy controls, pre‐HD individuals exhibited lower connectivity strength in the left putamen, the right anterior cingulate and the left medial prefrontal cortex. Pre‐HD individuals close to the onset of motor symptoms additionally exhibited lower connectivity strength in the right putamen and the left superior frontal cortex. The connectivity strength in the left putamen was associated with several clinical measures including CAG repeat length, Unified Huntington's Disease Rating Scale motor score and predicted years to manifest symptom onset. Conclusion: These findings suggest that early prefrontal connectivity abnormalities in pre‐HD individuals are modulated by cognitive demand.     

Surface EMG profiles during different walking cadences in humans

The ensemble electromyogram (EMG) patterns associated with different walking cadences were examined in 11 normal subjects. Five muscle groups were studied: the rectus femoris, vastus lateralis, lateral hamstring, tibialis anterior and soleus muscles of the right lower extremity. The myoelectric signals were telemetered, full-wave rectified and smoothed. Subjects walked at cadences of 115, 95 and 75 steps/min. Footswitches indicated the different phases of the stride. Six or more strides per subject were averaged for each cadence. Cadence-related changes in (1) mean EMG amplitude during stance, and during swing, and (2) the shape of the EMG patterns, were analyzed. One-way repeated-measures analyses of variance on the mean EMG amplitude in stance and in swing revealed significant changes with cadence (P less than 0.05) in all muscles examined. The magnitude of these changes could be related to the mechanical function of the muscles involved. The shape of the EMG patterns generally remained similar at the different cadences. The timing of EMG activity was closely related to the normalized stride time and remained invariant at different cadences.     

Gait disturbances related to dysfunction of the cerebral cortex and basal ganglia

This review aimed to characterize the gait disturbances in Parkinson disease (PD) and highlight how a rehabilitation program would affect the care of patients with PD. The typical PD gait is a type of hypokinetic gait characterized by reduced stride length and velocity; shortening of the swing phase; and increase in the stance phase, double-limb support duration, and cadence rate. In the advanced phase of PD, start hesitation, shuffling and festinating gait, propulsion, and freezing of gait (FOG) become remarkable. Notably, in PD, attention may influence gait control, and sensory cueing may improve the stride length. Our study on gait impairment in PD by using a three-dimensional motion analysis system revealed that the stride length and walking speed decreased, but there was no change in cadence. The decreased stride length was due to reduction in the range of movement at the leg and pelvic joints. A 4-week physical rehabilitation program for PD improved the stride length and walking speed;this was achieved by increasing the range of movement of at the leg and pelvic joints. We also assessed the effects of a rehabilitation program for patients with PD who experienced FOG. Although the lower limb function was more impaired in patients with PD and FOG than in those with PD without FOG, the rehabilitation program was effective even for patients with PD and FOG. FOG might be associated with functional impairment of the lower limb as well as dysfunction of the fronto-basal ganglia circuit. We also reported 3 cases of camptocormia (bent spine syndrome) with autonomic dysfunction and rapid eye movement (REM) sleep behavior disorders (RBD) and compared their symptoms with those reported elsewhere. We think that the pedunculopontine nuclear area may control the postural muscle tone and locomotion in PD. On the basis of the results of our rehabilitation programs, we speculate that physical modalities may modify synaptic plasticity by utilizing the cerebellar and/or afferent sensory system. These alternative systems are believed to be functionally intact in patients with PD.     

Quantitative assessment of retropulsion of the hip,excessive hip external rotation,and excessive lateral shift of the trunk over the unaffected side in hemiplegia using three-dimensional treadmill gait analysis

Background: Gait assessment is important to determine the most effective strategy to regain gait function during stroke rehabilitation. To understand the mechanisms that cause abnormal gait patterns, it is useful to objectively identify and quantify the abnormal gait patterns. Objective assessment also helps evaluate the efficacy of treatments and can be used to provide suggestions for treatment.

Objective: To evaluate the validity of quantitative indices for retropulsion of the hip, excessive hip external rotation, and excessive lateral shift of the trunk over the unaffected side in hemiplegic patients.

Methods: Forty-six healthy control subjects and 112 hemiplegic patients participated. From the 112 patients, 50 patients were selected into each abnormal gait pattern with some overlap. Participants were instructed to walk on a treadmill and were recorded using a three-dimensional motion analysis system. An index to quantify each of the three abnormal gait patterns was calculated from the three-dimensional coordinate data. The index values of patients were compared with those of healthy subjects and with the results of observational gait assessment by three physical therapists with expertise in gait analysis.

Results: Strong correlation was observed between the index value and the median observational rating for all three abnormal gait patterns (?0.56 to ?0.74). Most of the patients with an abnormal gait pattern had a higher index value than the healthy subjects.

Conclusions: The proposed indices are useful for clinical gait analysis. Our results encourage a more detailed analysis of hemiplegic gait using a motion analysis system.